Predicting Heart Attacks

By Kyle Phong

Published 1:55 PM EST, Sat June 12, 2021

Introduction

According to the CDC, someone has a heart attack every 40 seconds in the United States.  With heart disease being the leading cause of death in the US, one wonders how can heart attacks be prevented. Doctors recommend lifestyle changes such as a balanced diet and avoiding smoking. Recently, a research team at the University Hospital of the RWTH Aachen, Germany led by Dr. Milzi developed a method of predicting heart attacks using an advanced imaging system.

What is a heart attack?

A heart attack, medically known as a myocardial infarction, is blockage of blood flow to the heart, resulting in a section of the heart’s muscle beginning to die.  The arteries are typically blocked by a buildup of plaque, a combination of fats, calcium, and other substances in the blood.  Then, a layer of tissue called the fibrous cap surrounds the plaque.  Rupturing of the fibrous cap will cause a blood clot to form, completely blocking blood from reaching the heart through that artery.

NHLBI, “Heart with Muscle Damage and a Blocked Artery”

Methods

There have been prior studies of plaque and what puts them at high risk of rupturing, yet the exact reasoning behind them are still unknown.  Dr. Milzi and her team utilized optical coherence tomography (OCT) to take high resolution photos of coronary plaques in 20 patients with type 2 diabetes as well as chronic coronary syndrome or acute coronary syndrome.  Next, they analyzed stress concentrations using kilopascals as a possible predictor of plaque rupture.  

eLife, “Figure 5: Exemplary reconstruction of a coronary plaque”

The images above display an OCT image (left) and a sample reconstruction (right) of a coronary artery containing plaque.  The reconstruction shows the fibrous cap in red, lipid core plaque in yellow, rest of the vessel in gray.  The research team utilized this sample reconstruction in simulations to test the close association between stress and plaque rupture.  They noticed that ruptured plaques showed greater stress concentrations compared to plaques that have not ruptured.  Using this new information, they found locations with high stress concentrations and predicted that ruptures were likely to occur there.

Conclusion  

Studying the stress distribution in arteries is an additional way to predict future heart attacks, especially among patients at high risk.  With the use of OCT imaging, we can improve the treatment of coronary heart disease and continue to fight against the leading cause of death in the United States.  Before applying this newfound knowledge in a clinical setting, this study must be automated and further analyzed with a greater number of patients.

Kyle Phong, Youth Medical Journal 2021

References

eLife, “Coronary plaque composition influences biomechanical stress and predicts plaque rupture in a morpho-mechanic OCT analysis”, 11 May 2021 https://elifesciences.org/articles/64020

News Medical Life Sciences, “New approach could allow cardiologists to predict future heart attacks in high-risk patients”, 19 May 2021 https://www.news-medical.net/news/20210519/New-approach-could-allow-cardiologists-to-predict-future-heart-attacks-inhigh-risk-patients.aspx

Centers for Disease Control and Prevention, “Heart Disease Facts” https://www.cdc.gov/heartdisease/facts.htm

National Heart, Lung, and Blood Institute, “Heart Attack” https://www.nhlbi.nih.gov/health-topics/heart-attack

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